The COVID-19 pandemic has contributed to a blood supply crisis at a scale never seen before, but healthcare professionals can help to reverse the trend.
Blood supply shortages are nothing new. However, the COVID-19 pandemic has created unprecedented need. When combined with other challenges, such as severe winter weather and supply chain issues, the pandemic has helped to create a dire need for blood donations that has not been seen in at least 10 years — a sustained low blood inventory level that exceeds any such crisis that the Red Cross has seen since its current national inventory management systems began tracking such data.
A deep need for blood donations
“The blood supply levels have remained at historically low levels,” says Jessa Merrill, biomedical services communicator at the Red Cross. “Typically, following a public appeal we experience an increase in blood donations that helps build back our supply week by week until we are able to once again maintain a sufficient blood inventory for our hospital partners. Unfortunately, amid the Delta and Omicron variants, as well as other compounding pandemic factors, that did not occur. While both hospitals and blood centers have developed strategies to manage through shorter periods of limited blood supplies, a prolonged and sustained blood shortage has had a much deeper impact on patient care.”
It is estimated that nearly 30,000 units of red blood cells are needed every day in the U.S., according to Red Cross statistics. One individual patient who is injured in a car accident, for example, could require as many as 100 units of blood. That translates into a patient needing a blood donation somewhere in this country every two seconds.
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A constant refrain
Pandemic aside, the need for blood is relatively constant, as donated red blood cells must be utilized within 42 days, while blood platelets must be transferred to another patient within five days.
Healthcare professionals can assist the call for donations not only by being donors themselves, but also by communicating more accurate information and dispelling unfounded concerns about giving blood that might exist among their eligible patients and other potential donors.
Blood types
There are eight blood types identified by the Red Cross as the most common (A+, A-, B+, B-, O+, O-, AB+, and AB-). Blood types are determined by the presence of or absence of the A and B antigens, substances that can trigger immune responses when something foreign enters into the body. Antigens can trigger the immune system to attack transfused blood, necessitating that all blood transfusions be carefully assessed for correct blood typing and cross-matching.
In addition to the A and B antigens, a protein known as the Rh factor can be either present (+) or absent (–). Rh-negative blood can be given to Rh-negative patients, and Rh-positive or Rh-negative blood can be given to Rh-positive patients. (The rules for donating plasma are reversed.)
There are also more than 600 other known antigens that lead to a designation for some individuals to be carrying “rare blood types,” which can be unique to ethnic or racial groups. (The Red Cross offers an online interactive graphic that displays more information about matching blood types for transfusions here.)
A high demand
Individuals who carry Type O-negative blood are considered universal red cell donors, while those who carry Type AB blood are identified as universal plasma donors.
Type O is the blood most often requested among hospitals across the country and is routinely in short supply due to the need among emergency department patients and infants who are born with an immune deficiency.
The Red Cross estimates that approximately 45% of White individuals are Type O (positive or negative) while 51% of Blacks and 57% of Hispanics are Type O, which places a particular importance on blood donations that are received from minority and diverse populations.
Only 7% of the U.S. population carries O-negative blood, but the need for O-negative blood is always highest because it is used most often during emergencies. The need for O-positive blood is also typically high, as it is the most frequently occurring blood type.
According to Merrill, recent weeks have brought about more donations to help restock hospital shelves, but the blood supply remains vulnerable and the Red Cross has been forced to cancel more than 600 blood drives due to pandemic-related staffing shortages. An estimated 20,000 blood and platelet donations have thus gone uncollected during this time.
Assessing patient needs
While the World Health Organization has provided some guidelines (Clinical Transfusion Practice: Guidelines for Medical Interns), limited blood inventory has forced healthcare professionals nationwide to make difficult decisions about how to prioritize patients who can and cannot receive immediate blood transfusions.
Many hospitals nationwide have increased the number of blood drives hosted at their facilities, including for staff members who are willing to donate.
Throughout 2021, healthcare facilities ranked No. 3 in hosting blood drives, only trailing civic community organizations and religious organizations, according to Merrill. “We monitor the blood supply daily as our inventory fluctuates from day-to-day as donations come in and go out,” she said. “In addition, we work with our hospital partners to help prioritize needs.”
As hospitals resume surgical procedures and patient treatments that were temporarily paused due to the pandemic, eligible donors are being urged to give blood to ensure that supplies become more are readily available for patients as needed.
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COVID-19 and blood donations
The Red Cross continues to test all blood, platelet, and plasma donations for the presence of COVID-19 antibodies. Plasma from whole blood donations that tests positive for the antibodies could be used to help those patients who have tested positive for the virus and are also in need of convalescent plasma transfusions. “There is [also] no evidence that shows COVID-19 is transmissible via blood transfusion,” Merrill said.
While Red Cross officials are unaware of any data that proves that those individuals who might develop COVID-19 after receiving a routine blood transfusion (red cells or platelets) would have better outcomes with donated antibodies, Merrill says that there is new clinical data that show that immunocompromised patients could benefit from receiving COVID-19 convalescent plasma as part of their treatment.
The Red Cross does not currently collect and distribute convalescent plasma, but officials are currently evaluating if there’s a need to resume the convalescent plasma program in the future to help ensure that all patients who are diagnosed with COVID-19 have all treatment options available to them.
Blood donations and the vaccine
Related to the COVID-19 vaccine, typically there’s no deferral time required between inoculation with a U.S.-approved vaccine and blood donation if the patient is symptom free and feeling healthy at the time of donation.
However, it is necessary to know the name of the manufacturer of the vaccine that has been administered to determine one’s eligibility to give blood.
COVID-19 safety during blood donations
In addition to its traditional infection control standards, the Red Cross has increased its vigilance during the pandemic to include:
- Enhanced disinfecting of surfaces and equipment
- Providing hand sanitizer before entering the donation facility and throughout the donation appointment
- Following social distancing practices between donors, including donor beds, as well as waiting rooms and refreshment areas
- Regular laundering of blankets typically used by donors
- Encouraging donors to bring their own blankets
- Requiring all participants and staff members at blood drives and blood donation centers to wear a facemask regardless of vaccination status
- Standard staff health assessments prior to all blood drives
- Accepting blood only from eligible, healthy donors
A helping hand
Aside from donating blood when eligible, the nation’s healthcare workforce can impact the ongoing blood supply by volunteering to staff blood collections across the country and by communicating with patients about the safety precautions that are in place to keep them safe while donating during the pandemic.
The Red Cross also offers an online resource where providers and patients can schedule upcoming appointments to help prevent further blood shortages.
